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International Dental Journal logoLink to International Dental Journal
. 2020 Nov 6;61(6):287–296. doi: 10.1111/j.1875-595X.2011.00064.x

Herbs in dentistry

Jamile B Taheri 1, Somayyeh Azimi 2,*, Nasrin Rafieian 3, Hosein Akhavan Zanjani 4
PMCID: PMC9374842  PMID: 22117784

Abstract

Herbs have been used for centuries to prevent and control disease. Herbal extracts are effective because they interact with specific chemical receptors within the body and are in a pharmacodynamic sense, drugs themselves. By using herbal medicines, patients have averted the many side effects that generally come with traditional medicines, but this does not mean that side effects do not occur. Only knowledgeable practitioners can prescribe the right herb and its proper dosage. Herbal medicines had been considered in every culture, however, pharmaceutical companies overturned this type of thinking. Now, pharmaceuticals are called traditional and herbs are libeled as the ‘alternative’. The biggest challenge and problem is lack of information about the effect of herbs in oral tissues, mechanism of effect, and side effects. Several popular conventional drugs on the market are derived from herbs. These include aspirin (from white willow bark), digitalis (from foxglove), and sudafed (modelled after a component in the plant ephedra). Herbal products can vary in their potency. Therefore, care must be taken in selecting herbs, even so, herbal medicines have dramatically fewer side effects and are safer to use than conventional medications. The herbs described in this article are Bloodroot, Caraway, Chamomile, Echinacea, Myrrh, Peppermint, Rosemary, Sage, Thyme, Aloe Vera, Propolis, and a summary of other herbs that are useful in dentistry. Herbs may be good alternatives to current treatments for oral health problems but it is clear that we need more research.

Key words: Oral health, oral health promotion

INTRODUCTION

Practitioners and consumers of complementary and alternative medicine (CAM) are no longer at the periphery of clinical practice1. Herbal medicine is a popular form of CAM2. Herbs, botanically speaking, are any plants that lack the woody tissue characteristic of shrubs or trees. More specifically, herbs are plants used medicinally or for their flavour or scent. Herbs with medicinal properties are a useful and effective source of treatment for various disease processes. Many drugs used in Western medical science called allopathic medicine have their origin in medicinal plants3., 4..

Many who support herbal therapies, believe that extracting the chemical rather than using the whole plant eliminates such active ingredients as minerals, volatile oils, bioflavonoids, and other substances that support a particular herb’s medicinal properties3., 4..

Herbs are used to cleanse the blood, warm and stimulate the body, increase surface circulation, increase elimination of wastes, reduce inflammation, and calm and soothe irritation. Herbs may be used internally as pills, syrups, and infusions, or externally as poultices, plasters, and liniments. A topical application of clove oil, for instance, will stop the pain of toothache. Moist herbal wraps, either hot or cold, can be used on specific affected parts of the body. These wraps are especially effective for sore, tense muscles such as those in the neck, shoulders, back, or jaw when temporomandibular joint syndrome (TMJ) is present3., 4..

There is an urgent need for a use of Evidence Based Herbal Medicine and the efficacy and safety of herbal remedies. The section on each herbal preparation contains information on uses, pharmacology, evidence, adverse effects, and interactions and cautions, along with dosages, and a summary of herbs that are useful in dentistry. The evidence is associated with significant adverse effects, interactions, or risks to certain populations with herbal medicine. The accumulation of evidence is a dynamic and rapid process with many new clinical trials of herbal remedies being undertaken and published each year4. As a result, Evidence-Based Herbal Medicine lacks the contribution of more recent trials on herbal products5., 6., 7.. This article provides useful information on use of herbs, especially in dentistry.

Bloodroot (Botanical name: Sanguinaria Canadensis) (Figure 1)

Figure 1.

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Bloodroot (Botanical name: Sanguinaria Canadensis).

Alkaloids – principally sanguinarine – constitute the primary active compounds in bloodroot. These are used for gingivitis and periodontal disease and sometimes used in toothpaste or other oral hygiene products because they inhibit the growth of oral bacteria8., 9.. Bloodroot tincture is sometimes included in cough-relieving formulas, and 10 drops or less may be taken three times per day10.

Side effects

Although previous studies have suggested the long-term use of dental products containing sanguinarine is safe, a recent report suggests that use of dental preparations containing blood root may be associated with leukoplakia – a condition characterised by white spots or patches in the mouth that is thought to be precancerous11., 12.. Only small amounts of bloodroot should be taken, since amounts as small as 1 ml of tincture or 1 g can cause nausea and vomiting10., 13.. Long-term use or overdose of bloodroot can also cause stomach pain, diarrhoea, visual changes, paralysis, fainting, and collapse14. Long-term oral intake of sanguinarine-contaminated cooking oils has been linked in India to glaucoma, oedema, heart disease, miscarriage, and diarrhoea15. The plant is unsafe for use in children and should not be used by pregnant or lactating women. Recently the practice of applying ointments containing bloodroot, such as the so-called ‘black salve’, has been promoted for treatment of skin and other types of cancer16.

Caraway (Botanical name: Carum carvi) (Figure 2)

Figure 2.

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Caraway (Botanical name: Carum carvi).

Caraway contains 3–7% volatile oil, with the main components divided into carvone (50–60%) and limonene (40%)10. Caraway may help in gingivitis or periodontal disease (as a mouth wash) and to alleviate bowel spasm17. It has been used with success in combination with enteric-coated peppermint oil in the treatment of irritable bowel syndrome (IBS)18., 19.. People using this combination reported experiencing less pain and noted an overall improvement in their bowel symptoms compared to those who took a comparable placebo. A combination of caraway with the other carminative herbs (anise and fennel) has shown to be helpful in flatulence and mild abdominal cramping, especially in children. Some properties of caraway include: antihistaminic, antimicrobial, antiseptic, diuretic, expectorant, spasmolytic, caraway has been used as a flavour component in toothpaste, mouthwash products, cosmetics and perfumes, and as a flavouring in foods. It is also a traditional remedy for dyspepsia, intestinal colic, menstrual cramps, poor appetite, laryngitis, and bronchitis20.

Side effects

Caraway is generally safe for use. However, the purified volatile oil should not be used by children under 2 years of age, as oil from caraway and other herbs in the Umbelliferae family can be irritating to the skin and mucous membranes20., 21..

Chamomile (Botanical name: Matricaria recutita) (Figure 3)

Figure 3.

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Chamomile (Botanical name: Matricaria recutita).

The flowers of chamomile contain 1–2% volatile oils22. Other active constituents include the flavonoids, apigenin, luteolin, and quercetin. These active ingredients contribute to chamomile’s anti-inflammatory, antispasmodic, and smooth-muscle relaxing action, particularly in the gastrointestinal tract23., 24., 25., 26., 27..

It also is used for gingivitis and periodontal disease as a mouth wash. Topical applications of chamomile have been shown to be moderately effective in the treatment of eczema22. One double-blind trial found it to be about 60% as effective as 0.25% hydrocortisone cream28. Topical use of chamomile ointment was also found to successfully treat mild stasis ulcers bed sores in elderly bedridden patients29. In dentistry chamomile is used as mouthwash to prevent periodontal disease. Chamomile is often taken three to four times daily between meals as a tea. Common alternatives are to use 2–3 g of the herb in tablet or capsule form or 4–6 ml of tincture three times per day between meals. One to two capsules containing 300–400 mg may be taken three times daily. Topical creams or ointments can be applied to the affected area 3–4 times daily30.

Side effects

Allergic reactions to chamomile have been reported31. These reactions have included bronchial constriction with systemic use and allergic skin reactions with topical use32. While reports of such side effects are uncommon, people with allergies to plants of the Asteraceae family (ragweed, aster, and chrysanthemums), as well as mugwort pollen should avoid using chamomile33. Chamomile is usually considered to be safe during pregnancy or breast-feeding. However, there is one case report in which a pregnant woman who took chamomile as an enema had an allergic reaction that led to the death of her newborn34.

Echinacea (Common name: Purple coneflower) (Figure 4)

Figure 4.

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Echinacea (Common name: Purple coneflower).

Echinacea is thought to support the immune system by activating white blood cells35. Three major groups of constituents may work together to increase the production and activity of white blood cells (lymphocytes and macrophages), including alkylamides/polyacetylenes, caffeic acid derivatives, and polysaccharides The mouth wash of Echinacea is effective in gingivitis and periodontal disease in combination with sage, peppermint oil, menthol and chamomile36.

Side effects

No acute or chronic toxicity reactions have ever been reported in the long history of use of echinacea. Chronic administration of echinacea to rats at doses many times the human therapeutic dose produced no toxic effects37.

Several double-blind studies have confirmed the benefit of echinacea for treating colds and flu38., 39., 40.. In terms of other types of infections; research in Germany using injectable forms or an oral preparation of the herb along with a medicated cream (econazole nitrate) reduced the recurrence of vaginal yeast infections as compared to women given the cream alone41.

Myrrh (Botanical name: Commiphora molm) (Figure 5)

Figure 5.

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Myrrh (Botanical name: Commiphora molm).

The three main constituents of myrrh are the resin, the gum, and the volatile oil. The resin has reportedly been shown to kill various microbes and to stimulate macrophages42. Myrrh also has astringent properties and has a soothing effect on inflamed tissues in the mouth and throat. Studies continue on the potential anticancer and pain-relieving actions of myrrh resin43., 44..

In a preliminary trial, patients with a parasitic infection were treated with a combination of resin and volatile oil of myrrh, Myrrh is used for topical treatment of mild inflammations of the oral and pharyngeal mucosa45. It is also used as a gargle to treat pharyngitis and tonsillitis and as a mouthwash for gingivitis and ulcers46. Topical use is approved for the treatment of small wounds, for nasal congestion from the common cold, and for local application as an anodyne to treat infections of the buccal cavity and/or the oropharynx46., 47.. Myrrh tincture is used for inflammations of the gums and oral mucosa such as gingivitis and stomatitis48.

For making mouthwash, add 30–60 drops of tincture to a glass of warm water.

Apply the undiluted tincture to the affected areas on the gums or the mucous membranes of the mouth and paint with a brush or swab, 2–3 times daily.

Side effects

None known49.

Peppermint (Botanical name: Mentha piperita) (Figure 6)

Figure 6.

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Peppermint (Botanical name: Mentha piperita).

Peppermint leaves yield approximately 0.1–1.0% volatile oil which is composed primarily of Menthol (29–48%) and menthone (20–31%)50. Peppermint oil is classified as a carminative (prevents and relieves intestinal gas)51. Peppermint oil or peppermint tea is often used to treat gas and indigestion.

Three double-blind trials found that enteric-coated peppermint oil reduced the pain associated with intestinal spasms, commonly experienced in irritable bowel syndrome (IBS)51., 52., 53.. Peppermint oil’s relaxing action also extends to topical use. When applied topically, it acts as an analgesic and reduces pain54. A trial of topical peppermint oil applied to the temples of healthy volunteers (with or without eucalyptus oil) found that peppermint oil had a muscle-relaxing action and it decreased tension55. Topical peppermint oil alone reduced pain in people with tension headaches as well. Peppermint may interfere with iron absorption. Peppermint oil can be used for toothache by soaking a cotton ball in the oil and placing it in the cavity or rubbing it on the tooth. Peppermint leaf tablets and capsules, 3–6 g per day, can be used as a mouthwash to relieve gum inflammation. For headaches, a combination of peppermint oil and eucalyptus oil diluted with base oil can be applied to the temples at the onset of the headache and every hour after that or until symptom relief is noted56.

Side effects

Peppermint tea is generally considered safe for regular consumption. Peppermint oil can cause burning and gastrointestinal upset in some people57. It should be avoided by people with chronic heartburn, severe liver damage, inflammation of the gallbladder, or obstruction of bile ducts58. People with gallstones should consult a physician before using peppermint leaf or peppermint oil. Some people using enteric-coated peppermint capsules may experience a burning sensation in the rectum. Rare allergic reactions have been reported with topical use of peppermint oil. Peppermint oil should not be applied to the face – in particular, the nose – of children and infants59.

Rosemary (Botanical name: Rosmarinus officinalisy) (Figure 7)

Figure 7.

Figure 7.

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Rosemary (Botanical name: Rosmarinus officinalisy).

This volatile oil, including eucalyptol (cineole), is considered a potent antibacterial agent, it is effective in chronic candidiasis60 and to relax smooth muscles in the lungs61.

Rosmarinic acid has antioxidant activity62 and another ingredient of rosemary, known as carnosol, has been shown to inhibit cancer formation in animal studies63. No human studies have confirmed rosemary’s use for these conditions. The oil possesses antibacterial and antifungal properties, and antimicrobial activity has been documented towards moulds, Gram-positive and Gram-negative bacteria including Staphylococcus aureus, Staphylococcus albus, Vibrio cholerae and Escherichia coli. Carnosol and ursolic acid inhibit a range of food spoilage bacteria64.

Tea can be prepared by adding two teaspoons (10 g) of herb to one cup (250 ml) of boiling water and allowing it to steep in a covered container for 10–15 minutes. This tea can be taken several times per day. Rosemary tincture, 1/2 to one teaspoon (2–5 ml) three times per day, may also be used. The concentrated volatile oil should not be taken systemically65.

Side effects

There is no evidence to indicate that intermittent intake of moderate amounts of rosemary poses any threat during breast-feeding. However, internal intake of the herb and oil should be avoided during pregnancy because the oil may act as an agent that may induce abortion. Frequent use of rosemary could, in theory, promote the development of iron deficiency in susceptible individuals66.

Sage (Botanical name: Salvia officinalis) (Figure 8)

Figure 8.

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Sage (Botanical name: Salvia officinalis).

The volatile oil of sage contains the constituent alpha- and beta-thujone, camphor, and cineole67. It also contains rosmarinic acid, tannins and flavonoids. In modern European herbal medicine, a gargle of sage tea is commonly recommended to treat a sore throat, inflammations in the mouth, and gingivitis68. Sage oil has antibacterial, antifungal, and antiviral activity which may partially explain the effectiveness of sage for these indications68.

Sage is used to remedy inflammation of the mouth, throat and tonsils68. For treatment, 3 g of the chopped leaf can be added to 150 ml of boiling water and strained after 10 minutes69. This is then used as a mouthwash or gargle several times daily. Alternatively, one may use 5 ml of fluid extract (1:1) diluted in one glass of water, several times daily. For systemic use, the same tea preparation described above may be taken three times per day or as an infusion by pouring a cup of boiling water onto 1–2 teaspoonfuls of the leaves and let infuse for 10 minutes. This should be drunk three times a day. As a mouthwash: put two teaspoonfuls of the leaves in half a litre (one pint) of water, bring to the boil and let stand, covered, for l5 minutes. Gargle deeply with the hot tea for 5–10 minutes several times a day69.

Side effects

Small amounts of sage for long periods of time may cause increased heart rate and mental confusion. Very high amounts (several times greater than one receives if taking sage as instructed above), may lead to convulsions.

Extracts of sage made with alcohol are likely to be higher in thujone than those made with water. Sage oil should never be consumed without being first diluted in water. Sage should not be used systemically during pregnancy. These concerns do not extend to the use of sage as a gargle or mouthrinse. Sage should be avoided when fever is present68.

Thyme (Botanical name: Thymus vulgaris) (Figure 9)

Figure 9.

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Thyme (Botanical name: Thymus vulgaris).

The primary constituents are the volatile oils, which include the phenols, thymol and carvacol70. These are complemented by the actions of flavonoids. Thyme, either alone or in combination with herbs such as sundew, continues to be one of the most commonly recommended herbs in Europe for the treatment of dry, spasmodic coughs as well as whooping cough71.

Use a salve made of thyme, myrrh, and goldenseal to treat oral herpes. Also use thyme to treat chronic candidiasis and halitosis71.

A fluid extract, 1/4–3/4 teaspoon (1–4 ml) three times per day, can also be used72.

Side effects

Thyme herbal preparations are generally safe. However, a spasmodic cough, particularly in a young child, may be dangerous and a healthcare professional should be consulted before deciding on the proper course of treatment. The use of thyme by pregnant or breast-feeding women is considered to be safe. Thyme oil should be reserved for topical use, as when ingested it may lead to dizziness, vomiting, and breathing difficulties73. Some people may be sensitive to use of thyme oil topically on the skin or as a mouthrinse73.

Aloe vera (Figure 10)

Figure 10.

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Aloe Vera.

The components of aloe vera include: vitamins, enzymes, minerals, sugars, fatty acids, amino acids and salicylic74. Aloe vera (in the form of a gel) improves healing and so can be used for burns, insect bites and many other skin lesions. Aloe and propolis hand cream prevents skin damage resulting from frequent hand washing and the wearing of latex gloves; the aloe activator spray is excellent for throat infections, painfully erupting wisdom teeth and joint pains; aloe juice can also be taken as a drink. This is used in conjunction with any topical treatment for skin lesions, joint lesions and, in itself, as amelioration in irritable bowel syndrome75.

The juice is also a strong detoxifying agent and if used in conjunction with the planned removal of mercury amalgams acts as a scavenging agent for mercury, a neuro-sedative and immune enhancer. Because of the many properties and functions of aloe, it is a powerful nutritional supplement and anti-oxidant. It protects and promotes healing. The gel has been shown to be bactericidal and fungicidal against Candida albicans (the cause of moniliasis or ‘denture sore mouth76.

The aloe vera gel formula was found to be virucidal against Herpes simplex and Herpes zoster viruses and to be just as effective as Prednisolone and Indomethacin, without having the long term toxicity of either drug77.

Aloe vera gel formula is nontoxic, bactericidal, veridical, and fungicidal against a broad range of micro-organisms, and a stimulator of cellular life-extension.

There are eight main uses of Aloe Vera in dental practice:

  • •

    Applications directly to the the sites of periodontal surgery

  • •

    Applications to the gum tissues when they have been traumatised or scratched by toothbrush dentifrice abrasion, sharp foods, dental floss, and toothpick injuries

  • •

    Relief of chemical burns are relieved quickly from accidents with aspirin

  • •

    Extraction sites respond more comfortably and dry sockets do not develop when aloe vera is applied

  • •

    Acute mouth lesions are improved by direct application such as on herpetic viral lesions, aphthous ulcers, canker sores, and cracks occuring at the corners of lips. Gum abscesses are also soothed by the applications

  • •

    Other oral diseases, chronic in nature, respond to applications such as lichen planus and benign pemphigus and gingival problems associated with AIDS and leukaemia. Migratory glossititis, geographic tongue and burning mouth syndrome are improved

  • •

    Denture patients with sore ridges and ill-fitting dentures can benefit as fungal and bacterial contamination is reduced as is the irritation from inflammation

  • •

    Aloe vera can also be used around dental implants to control inflammation from bacteria contamination

Other oral disorders such as candidiasis, desquamative gingivitis, vesiculobullous diseases, acute monocytic leukemia, hematological disorders and nutritional problems all respond to aloe vera use as can diabetes mellitus, Sjorgen’s syndrome, menopausal patients and those on medications which can cause xerostomia or dry mouth. Aloe vera has an unlimited future in new applications, and in dentistry we are just on the cutting edge of promising uses for these anti-inflammatory, antiviral, and immunological benefits74., 75., 78..

Propolis

A list of possible actions of propolis includes: antibacterial, antifungal, antiviral (including anti HIV-1 activity), antioxidant, anticarcinogenic, antithrombotic and immunomodulatory79. The mechanism of the possible actions of propolis may be understood by reviewing research findings on some of the individual compounds found in it. It is difficult to study the mechanism of actions of more than one compound at a time. Therefore, the following descriptions apply only to single compounds. The contribution of any single compound to the possible action of such a complex substance as propolis is difficult to establish80. Caffeic acid phenethyl ester (CAPE) inhibits the lipoxygenase pathway of arachidonic acid, resulting in anti-inflammatory activity. CAPE is also known to have anticarcinogenic, antimitogenic and immunomodulatory properties. CAPE has been found to completely inhibit the activation of the nuclear transcription factor NF-Kappa B by tumour necrosis factor (TNF), as well as by other pro-inflammatory agents. The inhibition of NF-Kappa B activation may provide the molecular basis for its immunomodulatory, anticarcinogenic, anti-inflammatory and antiviral activities. It is possible that CAPE exerts its effects by inhibiting reactive oxygen species (ROS) production. ROS are known to play a major role in the activation of NF-Kappa B. Compounds in propolis found to have antibacterial activity include a polyisoprenylated benzophenone, galangin, pinobanksin and pinocembrin. The exact mechanism of antimicrobial action of these compounds is not known.

There is evidence that propolis has some broad antimicrobial activity and that it may have anti-inflammatory effects that could make it useful in the treatment of some forms of arthritis, among other disorders. There is also some evidence of anti-cancer activity.

Propolis is available in several different preparations, including lozenges, tablets, creams, gels, mouth rinses, toothpastes and cough syrups81.

Summary of other herbs that are useful in dentistry82

Alfalfa

  • •

    Useful in cases of haemorrhaging and fungal infections

Anises

  • •

    An anti-inflammatory herb, anise is commonly used in tea form to soothe the gums

Annatto

  • •

    Apply after tooth extraction or gum surgery

Black cohosh

  • •

    Use to relieve cramps in the jaw or neck

Burdock

  • •

    Burdock poultices are excellent for the relief of muscle tension and headaches associated with temporomandibular joint disorders (TMJ)

Catnip

  • •

    Drink catnip tea or take in capsules to help relaxation before dental treatment

Cayenne

  • •

    Saturate cotton with oil of cayenne and place it on an aching tooth for emergency relief

Chickweed

  • •

    Chickweed mouthwash soothes inflamed, irritated mouth tissues associated with oral cancer; it also helps to relieve pain from canker sores and other mouth sores

Cloves

  • •

    Rub oil of cloves on sore gums and teeth to ease pain

Comfrey

  • •

    Use as a compress to ease jaw tension and relieve the pain of jaw and tooth fractures or adjustments to braces

Dandelion

  • •

    Dandelion is useful for treating abscesses in the mouth

Elderberry

  • •

    Prepare mouthwash after gum surgery or after sutures have been placed

Evening primrose

  • •

    Rub evening primrose oil on sore, inflamed gums for temporary relief

Ginseng

  • •

    Use in a tonic to promote circulation and to help repair irritated gum tissue

Goldenseal

  • •

    When used as a toothpaste or mouthwash, goldenseal is excellent for soothing inflamed gums

Hops

  • •

    Prepare hop tea and drink as a remedy for toothache

Horsetail

  • •

    Use a horsetail mouthwash to relieve mouth and gum infections

Kelp

  • •

    Kelp taken daily will help ensure healthy gums and bones

Lobelia

  • •

    Drink to ease jaw pain

Marigold

  • •

    Use marigold as a mouthwash to help relieve ulcers, and to relax muscles associated with tension in the jaw joint and pressure from braces

Marjoram

  • •

    Prepare marjoram as tea. Drink hot to ease headaches and relieve toothache pain

Prickly ash

  • •

    Use to increase the flow of saliva

Rockrose

  • •

    Use rockrose mouthwash to soothe and heal canker sores and mouth ulcers

Shepherd’s purse

  • •

    Use the fresh tops of shepherd’s purse to help stop bleeding after tooth extraction

Skullcap

  • •

    Drink skullcap tea to relieve anxiety before a dental appointment

Summer savory

  • •

    Soak a cotton ball with summer savory oil and place it on a sore tooth or rub it on inflamed gums for temporary relief

Violet

  • •

    Mouthwash made from violets helps relieve the pain and tenderness from sores caused by oral cancer

Wintergreen

  • •

    The leaves have long been used to treat wounds and stop haemorrhages

  • •

    Wintergreen mouthwash is an excellent astringent and antiseptic

Wood betony

  • •

    Drink wood betony tea to promote relaxation before a dental appointment

Yarrow

  • •

    Use yarrow mouthwash to promote healing of cuts in the mouth due to surgery, tooth cleaning, and braces

Acknowledgements

This article was based on a undergraduate thesis by Dr Zanjani, which was successfully completed with the close cooperation of the Oral Medicine Department of the Dental School of Shahid Beheshti, University of Medical Sciences.

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